Organization
BACK TO LIFE INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GRACIE GONZALEZ PADILLA (CHIEF EXECUTIVE OFFICER)
(623) 518-9552
Entity
Organization
Contact information
Practice address
6420 W COCOPAH ST, PHOENIX, AZ 85043
(602) 999-2400
(623) 444-7829
Mailing address
PO BOX 8237, PHOENIX, AZ 85066-8237
(602) 999-2400
(623) 444-7829
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
10/08/2019
Last updated
10/08/2019
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